Healthcare Provider Details

I. General information

NPI: 1841308889
Provider Name (Legal Business Name): TIM CHARLES MCQUINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE M/S G-0035
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE PO BOX 50010
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-1417
  • Fax:
Mailing address:
  • Phone: 206-987-8473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number18087
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number60101082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: